Remote Billing Lead, Healthcare Revenue Cycle Specialist

AIS Healthcare; Dallas (TX); Remote; USD 70,000 - 90,000; Full time

Job summary

Advanced Infusion Care seeks a Billing Lead to guide the home infusion billing process from ticket confirmation through submission of HCFA 1500 claims. You will act as SME, manage denial resolution, train staff, and collaborate with Pharmacy and Collections to optimize reimbursement.

Ideal candidates bring 5+ years in healthcare billing, leadership experience, and knowledge of Waystar or similar platforms. This full-time role requires adherence to HIPAA and regulatory standards.

Qualifications

• Strong understanding of Revenue Cycle Management functions and how they integrate across the billing and collections process.
• Ability to recognize, evaluate, and exercise good judgment in solving complex situations and advising in accordance with laws and regulations.
• Strong analytical and problem-solving skills with the ability to make timely, sound decisions.
• Excellent verbal and written communication and relationship-building skills, with the ability to prioritize, negotiate, and work with a variety of internal and external stakeholders.
• Exceptional attention to detail and accuracy.
• Strong work ethic with personal qualities of integrity, accountability, and credibility.

Responsibilities

• Oversee daily billing operations, including ticket review, billing holds, claim submission, rejections, corrected claims, and staff productivity and quality.
• Act as SME for all billing processes and escalation point for complex or aged billing issues.
• Review and follow up on open pharmacy delivery tickets to ensure timely and accurate billing.
• Monitor and resolve claims on billing hold reports; escalate unresolved items as necessary.
• Prepare and submit accurate electronic and paper HCFA 1500 claims.
• Work rejected claims queues in Waystar and resolve issues for timely resubmission; submit corrected claims as needed.
• Review claims for billing accuracy, including payer requirements, coding, NDCs, units, quantities, and infusion supplies.
• Perform routine quality reviews of billed claims and drive root-cause corrective actions.
• Partner with Collections to identify denials drivers and implement process improvements.
• Respond to questions from Collections, Pharmacy, and other internal departments.

Skills

RCM

Leadership

Training

HIPAA

Analytical

MS Office

Education

Bachelor's degree preferred

Tools

Waystar

Job description

Advanced Infusion Care seeks a Billing Lead to guide the home infusion billing process from ticket confirmation through submission of HCFA 1500 claims. You will act as SME, manage denial resolution, train staff, and collaborate with Pharmacy and Collections to optimize reimbursement.

Ideal candidates bring 5+ years in healthcare billing, leadership experience, and knowledge of Waystar or similar platforms. This full-time role requires adherence to HIPAA and regulatory standards.